Question

Nursing Report:

Mrs. Millie Larson is an 84 year old female who lives alone in a two story house and is usually very independent, was admitted from the emergency department 45 minutes ago. The patient’s only daughter, Dina Olsen, accompanied her mother to the hospital. According to the daughter, she had last seen her mother three days ago at which time Millie was alert and oriented x 3 but didn’t seem her usual talkative self. When Dina called yesterday, her mother seemed alert and oriented but stated she was very tired and was resting in bed. When the daughter visited today, she found Millie’s daily medication box on the kitchen table with medications from the last couple of days not taken. Uneaten food was found on the kitchen table with dirty pots and pans around. Dina found Millie in her bed with wet sheets, wet clothing, a flushed face and was unable to remember her daughter’s name. Dina drove Millie to the hospital. In the emergency department her vital signs were BP- 104/64; P-104; R-20; T-100.6. CBC and BMP were drawn and sent to lab. U/A was unable to be obtained. She is being admitted to a medical floor with new onset confusion, r/o UTI; dehydration

Social History:

Millie’s daughter is her only support system. The daughter works and cannot visit her mother every day. If she cannot visit, the daughter tries to call Millie daily. Millie’s husband Harold died 5 months ago. She has a cat Snuggles and 3 grandchildren who are very important to her. Millie is very active in her church singing in the church choir and funeral choir, but has cut back singing in the funeral choir since Harold’s death. Millie loves to cook and usually volunteers in the church kitchen but has cut back on her volunteering lately. Past Medical

History:

No known drug allergies. History of hypertension for 30 years; osteoarthritis for 20+ years; hypercholesterolemia; osteoporosis; and stress incontinence. Medications: captopril 25 mg po three times a day, Lipitor 40 mg po once a day, metoprolol 100 mg po once a day, furosemide 40 mg po twice a day, Fosamax 10 mg po once a day, Celebrex 200 mg po once a day, and tramadol 50 mg po prn arthritis pain.

What physical assessment findings will you see in the elderly that differs from the young adult?

What are some signs and symptoms of dehydration?

Discuss which electrolyte laboratory values are affected when a patient has dehydration and the causes.

After reading the patient history, what concerns do you have for this patient and why?

Explain with some detail the difference between delirium and dementia.

Why is the Braden Scale important for this patient?

Answer 1

In elderly, facial skin becomes dry, saggy, loose and wrinkled due to age-related decrease in subcutaneous fat, elasticity and moisture.they may develop cataract and glaucoma, may develop hearing difficulty.

in the musculoskeletal system, can find out muscle atrophy, involuntary movements and tremors, joints may be inflamed due to arthritis. may need assistance in activities in daily living such as bathing, feeding, toileting etc

some elderly may develop dementia, also fracture is a main complication in elderly due to falls.

signs and symptoms of dehydration

older adults don't feel thirsty until they get dehydrated.

• extreme thirst
• decreased frequency of urination
• bright coloured urine
• fatigue
• confusion
• dizziness

for children

• dry mouth
• lack of tears
• no wet diapers
• sunken eyes
• irritability

lab findings

• acid-base balance
• serum electrolyte( sodium, potassium, chloride,bicarbonate)
• blood urea nitrogen(BUN)
• urinalysis(colour and concentration)
• complete blood count(elevated hematocrit)
• urine/blood osmolality(evaluate water balance)
• stool culture (in case of diarrhea)